Impact of peripheral artery disease on short-term outcomes after percutaneous coronary intervention: A report from Japanese nationwide registry.

Atherosclerosis is a systemic process. As the population ages, increasingly more patients who undergo coronary revascularization are complicated with peripheral artery disease (PAD). However, the large body of evidence in this area has not been limited to analysis from trial-based data from younger and relatively uncomplicated patients in Western countries. The impact of PAD on the outcomes can differ by patient characteristics, and integrated analysis of large-scale data is necessary. J-PCI is a universal (all-comer) nationwide registration system in Japan, regulated and audited by professional society that controls national board-certification system. For the present study, we extracted data of 894,014 percutaneous coronary intervention (PCI) cases performed between 2014 and 2017 (mean age 70.2 years [standard deviation 11.0]). In-hospital outcomes of PAD and Non-PAD patients were compared. PAD was defined as a previous history of stenosis of peripheral arteries or abdominal aortic aneurysm. Primary outcome was in-hospital mortality, and multivariable modeling was performed. A total of 66,891 patients (8.1%) had PAD. Crude in-hospital mortality rate was higher in this group (0.99% vs. 0.67% in Non-PAD group). PAD was associated with an increased risk of in-hospital mortality (odds ratio [OR] 1.383 [95% confidence interval 1.251-1.528]). However, the impact of PAD differed by kidney condition (OR 1.578 [1.370-1.821] for patients with chronic kidney disease [CKD] and OR 1.234 [1.076-1.416] without CKD: P for interaction 0.005), and by clinical presentation: PAD was not associated with an increased risk of in-hospital mortality in patients undergoing PCI for silent ischemia (OR 1.211 [0.8701-1.685]: P for interaction 0.002). Presence of PAD was independently associated with in-hospital mortality in patients receiving PCI. However, its impact varied substantially by the patient background or indication of the procedure.

Déclaration de conflit d'intérêts

The authors have read the journal's policies and declare the following competing interests: KS received personal fees from Bayer, AstraZeneca and Bristol-Myers Squibb. TS received funding from Abbott Vascular, Dai-ichi Sankyo, Bayer, Sanofi, and Nipro. TA receives lecture fees from Astellas Pharma, AstraZeneca, Bayer, Daiichi Sankyo, and Bristol-Myers Squibb. YS receives Honorarium from·Otsuka Pharmaceutical, Daiichi Sankyo, Takeda Pharmaceutical,·Mitsubishi Tanabe Pharma, Medtronic Japan and Boehringer Ingelheim Japan, research grant from Edwards Lifesciences, FUJIFILM RI Pharma,·REGiMMUNE, and·Roche Diagnostics, and Scholarship (educational) grant/endowed chair from Otsuka Pharmaceutical, Johnson & Johnson, St. Jude Medical Japan, Daiichi Sankyo,·Takeda Pharmaceutical,·Mitsubishi Tanabe Pharma, Teijin Pharma Limited,·Boehringer Ingelheim Japan, Bayer Yakuhin, BIOTRONIK Japan, Boston Scientific, Medtronic Japan. TM has a research grant from Abbott vascular Japan. YI has research grants from Boston Scientific, Asahi intech, Nipro, Sanofi, Daiichi-Sankyo, and Terumo, and receives lecture fee from Asteras Amgen Biopharma, Astrazeneca, Abbott vascular, Sanofi, Daiichi-Sankyo, Boehringer-Ingerheim, Bayer, and Bristol Meyers-Squib. This does not alter our adherence to PLOS ONE policies on sharing data and materials.